HEADLINE: Medicare Advantage Plans Exaggerate Members’ Diseases to Make More Money

Teachers and other retired public employees, you are being defrauded of your money and earned compensation. How do Medicare Advantage Plans code for additional cash for themselves?

In addition to our government giving private Medicare Advantage Plans a better deal to allow them to make more money, the plans are openly overbilling and overcharging for services. They are gaming the system unless new governmental policy changes are implemented. This is a license to steal until legislators change the system.

What was done to the plans hoisted upon retired teachers by the Illinois overseers of their health plan coverage?

Medicare Advantage Plan Scam

Imagine having a healthcare plan shoved at you with a take-it-or-leave-it clause. You were sent the information in early to mid November, and you had to say yes-or-no by December 13. Also, even though other plans go from January to December, because of the lateness of this healthcare coverage offer, your plan would begin in February.

Most importantly, a short outline of the actual plan suddenly became available, and a fuller explanation of coverage was given a little later, but additional details were not available until well after you had agreed to it. Even then, not all details were revealed.

In addition: “Something as simple as enrolling in your favorite pharmacy’s prescription savings plan could enroll you in a Medicare Part D plan, thereby causing your TRAIL coverage to terminate.”
The Illinois Department of Central Management Services

That’s right, if you save money by using Walgreen’s or CVS’ pharmacy prescription plans, the plan cuts you out of the entire coverage and thrusts you into a different plan. Of course, you were not notified about this until after the plan was in effect.

Then, in July, you are told that the plan you agreed to is changing its Catastrophic Coverage. Try to figure out the legalese babble explaining this catastrophic-coverage-speak.

Remember that this healthcare coverage costs you lots of money taken directly from your monthly paycheck – for your premium. It also costs you an additional out-of-pocket deductible and out-of-pocket co-pays. This is not charity from the state’s taxpayers.

Who did this to retired teachers? The State of Illinois. The same legislators that were angry with retired teachers for threatening to take the state to court for passing a bill that was blatantly in violation of the protections of their pensions as spelled out in the Illinois constitution.

(The retired and active teachers did take it to court citing that many of the pension cutting legislators who voted for the bill agreed that the bill was indeed unconstitutional. Even the President of the Illinois Senate, John Cullerton, stated this during a recorded interview.)

A new federal study shows that many Medicare Advantage health plans routinely overbill the government for treating elderly patients — and have gotten away with doing it for years.”
The Center for Public integrity

“Despite its broad implications for Medicare spending, the study by HHS researchers Richard Kronick and W. Pete Welch has attracted scant notice in Washington. It was quietly posted late last month on an online research site run by the Centers for Medicare & Medicaid Services, part of HHS.”
Kaiser Health News

The increase in relative MA scores appears to largely reflect changes in diagnostic coding, not real increases in the morbidity of MA enrollees… Given the continuous relative increase in the average MA risk score, further policy changes will likely be necessary.”
Centers for Medicare & Medicaid Services



About Ken Previti

This entry was posted in betrayal, civic duty, fairness, government, greed, pensions, Uncategorized and tagged , . Bookmark the permalink.

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